Provider Demographics
NPI:1629529128
Name:CABRERA, ALLIZA ANNE DIZON (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:ALLIZA ANNE
Middle Name:DIZON
Last Name:CABRERA
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 LA CANYADA DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8260
Mailing Address - Country:US
Mailing Address - Phone:707-342-3331
Mailing Address - Fax:
Practice Address - Street 1:161 BUTCHER RD STE B
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5685
Practice Address - Country:US
Practice Address - Phone:707-305-1118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-25585103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-17-25585OtherBEHAVIOR ANALYST CERTIFICATION NUMBER